“Finally Friday!” ALJs, ZPICs and Extrapolation

Amy Fehn, a partner at Wachler Associates, goes over some recent experiences with ALJ hearings, including lost medical records — lost by the QIC! Amy also provides some excellent advice about some recent experiences with ZPICs and even extrapolation cases.

Articles from Academy Blog

“Scope Creep” in Appeals is Dead CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521.